Standards of Medical Care in Diabetes—2014

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doi:10.2337/dc14-s014

Cited by 3,642 publications

(1,882 citation statements)

References 601 publications

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“…The American Diabetes Association has defined normal as HbA1c <5.7 percent, prediabetes as HbA1c 5.7‐6.4 percent, and diabetes as HbA1c ≥6.5 percent 3. We defined dysglycemia as prediabetes or diabetes (HbA1c ≥5.7 percent).…”

Section: Methodsmentioning

confidence: 99%

“…The US Preventive Services Task Force has recommended screening for type 2 diabetes in asymptomatic adults with sustained blood pressure >135/80 mmHg 2. The American Diabetes Association has recommended screening for diabetes every 3 years in persons ≥45 years of age and in those <45 years of age with body mass index (BMI) ≥25 kg/m 2 and one or more risk factors for diabetes 3.…”

Section: Introductionmentioning

confidence: 99%

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Screening for prediabetes and type 2 diabetes in dental offices

Herman

Taylor

Jacobson

et al. 2015

J Public Health Dent

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ObjectivesMost Americans see dentists at least once a year. Chair‐side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices.MethodsWe recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age.ResultsIndividuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self‐reported body mass index ≥35 kg/m2 (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia.ConclusionsThere is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair‐side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high‐risk patients.Practical implicationsFurther studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost‐effectiveness of chair‐side screening.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Screening for prediabetes and type 2 diabetes in dental offices

Herman

Taylor

Jacobson

et al. 2015

J Public Health Dent

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“…Insulin therapy is an essential part of the management of type 1 diabetes 1, but is often associated with weight gain and hypoglycaemia 2, 3. Despite advances in insulin formulation and delivery, patients with type 1 diabetes often fail to reach the target HbA1c of <7% 1, 4.…”

Section: Introductionmentioning

confidence: 99%

“…Despite advances in insulin formulation and delivery, patients with type 1 diabetes often fail to reach the target HbA1c of <7% 1, 4. Inadequate glucose control can lead to acute conditions such as ketoacidosis 5, and to chronic complications including retinopathy, nephropathy and cardiovascular disease 6, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

Empagliflozin as adjunct to insulin in patients with type 1 diabetes: a 4‐week, randomized, placebo‐controlled trial (EASE‐1)

Pieber

Famulla

Eilbracht

et al. 2015

Diabetes Obesity Metabolism

158

165

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AimsTo investigate the pharmacodynamics, efficacy and safety of empagliflozin as adjunct to insulin in patients with type 1 diabetes.MethodsA total of 75 patients with glycated haemoglobin (HbA1c) concentrations of ≥7.5 to ≤10.5% (≥58 to ≤91 mmol/mol) were randomized to receive once‐daily empagliflozin 2.5 mg, empagliflozin 10 mg, empagliflozin 25 mg, or placebo as adjunct to insulin for 28 days. Insulin dose was to be kept as stable as possible for 7 days then adjusted, at the investigator's discretion, to achieve optimum glycaemic control. The primary exploratory endpoint was change from baseline in 24‐h urinary glucose excretion (UGE) on day 7.ResultsEmpagliflozin significantly increased 24‐h UGE versus placebo on days 7 and 28. On day 28, adjusted mean differences with empagliflozin versus placebo in changes from baseline in: HbA1c were −0.35 to −0.49% (−3.8 to −5.4 mmol/mol; all p < 0.05 vs. placebo); total daily insulin dose −0.07 to −0.09 U/kg (all p<0.05 vs placebo); and weight were −1.5 to −1.9 kg (all p < 0.001 vs. placebo). In the placebo, empagliflozin 2.5, 10 and 25 mg groups, respectively, adverse events were reported in 94.7, 89.5, 78.9 and 100.0% of patients, and the rate of symptomatic hypoglycaemic episodes with glucose ≤3.0 mmol/l not requiring assistance was 1.0, 0.4, 0.5 and 0.8 episodes per 30 days.ConclusionsIn patients with type 1 diabetes, empagliflozin for 28 days as adjunct to insulin increased UGE, improved HbA1c and reduced weight with lower insulin doses compared with placebo and without increasing hypoglycaemia.

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“…Hypoglycaemia occurs when blood glucose levels drop to below normal (defined as < 3.9 mmol/l by the American Diabetes Association 2), and is accompanied by symptoms such as anxiety, palpitations, weakness and confusion 3. In severe cases, hypoglycaemia can cause seizure, loss of consciousness, coma and even death 3.…”

Section: Introductionmentioning

confidence: 99%

Approach to assessing the economic impact of insulin‐related hypoglycaemia using the novel Local Impact of Hypoglycaemia Tool

et al. 2015

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AimTo provide estimates of the costs of severe and non‐severe insulin‐related hypoglycaemia in the UK using the Local Impact of Hypoglycaemia Tool.MethodsRates of hypoglycaemia were extracted from the UK Hypoglycaemia Study Group observational study. The costs of severe and non‐severe hypoglycaemic episodes in insulin‐treated adults with Type 1 and Type 2 diabetes were estimated from UK data sources. The rates and costs were then applied to specific populations to give an estimate of the cost of insulin‐related hypoglycaemia for the UK, a specific locality, or a user‐defined population. User‐specific rates and costs could also be applied.ResultsThe estimated cost of a hypoglycaemic episode can range from as much as £2,152 for severe episodes (for which the patient is admitted to hospital) to as little as £1.67 for non‐severe episodes. With a UK population of 64.1 million, the total estimated cost of managing insulin‐related hypoglycaemia is £468.0 m per year (£295.9 m for severe episodes, £172.1 m for non‐severe episodes). On a local health economy level, using a hypothetical general population of 100 000, the total cost of managing insulin‐related hypoglycaemia is estimated to be £730,052 per year (£461,658 for severe and £268,394 for non‐severe episodes).ConclusionsThe Local Impact of Hypoglycaemia Tool highlights the economic burden of insulin‐related hypoglycaemia. Non‐severe episodes are often overlooked because of their low individual cost, but their high frequency makes the cumulative cost substantial. The Local Impact of Hypoglycaemia Tool also shows clinicians and budget‐holders the economic impact of lower rates of hypoglycaemia.

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Standards of Medical Care in Diabetes—2014

Cited by 3,642 publications

References 601 publications

Screening for prediabetes and type 2 diabetes in dental offices

Screening for prediabetes and type 2 diabetes in dental offices

Empagliflozin as adjunct to insulin in patients with type 1 diabetes: a 4‐week, randomized, placebo‐controlled trial (EASE‐1)

Approach to assessing the economic impact of insulin‐related hypoglycaemia using the novel Local Impact of Hypoglycaemia Tool

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